# Efficacy and safety of use of ultrasound enhancing agent in patients hospitalized with COVID-19

## TL;DR

Using an ultrasound enhancing agent during heart scans in hospitalized COVID-19 patients improves diagnostic accuracy and management decisions without increasing short-term mortality.

## Contribution

This study demonstrates that ultrasound enhancing agents improve diagnostic yield and safety in critically ill hospitalized COVID-19 patients.

## Key findings

- Use of UEA increased the ability to answer TTE indications from 75.8% to 88.7%.
- UEA led to diagnostic changes in 36% of patients and management changes in 21.3%.
- No significant increase in 48-hour mortality was observed with UEA use.

## Abstract

The efficacy and safety of ultrasound enhancing agent (UEA) was unknown in the COVID-19 hospitalized patients. We set out to establish the utility of UEA and its safety profile.

A retrospective observational study of prospectively assessed hospitalized patients referred for transthoracic echocardiography (TTE) for suspected cardiac pathology due to COVID-19. The indications and subsequent ability to answer the indications for all TTE were reviewed, as well as impact on diagnosis and management. UEA safety was considered through 48 h mortality.

From a total of 364 patients (mean age 64.8yrs, 64% males) hospitalized with COVID-19 with TTE requested, an indication could be identified in 363, and 61 required administration of UEA. Standard TTE was able to answer the original indication in 275 (75.8%) patients. This was increased to 322 (88.7%) patients, a relative increase of 17.1%, with the use of UEA (p < 0.001). There was subsequent change in diagnosis in 22 out of 61 (36%) patients receiving UEA and change in management in 13 out of 61 (21.3%). There was no significant increase in 48 h (p = 0.14) mortality with UEA use. The patient population of TTE with UEA versus TTE without UEA differed in having a higher incidence of left ventricular systolic dysfunction, right ventricular dilatation, and self-defined white ethnicity.

The use of UEA in COVID-19 hospitalized patients, including those who were critically ill, provided incremental information when compared to TTE without UEA resulting in both changes in diagnosis and management plan and appears to be safe.